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HomeMy WebLinkAboutBLDG-21-006679 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �n BLDG 21-006679 �, CITY YARMOUTH MA DATE May 18,2021 PERMIT# JOBSITE ADDRESS 30 TRANQUIL TRAIL OWNER'S NAME DADOLY DWAIN A G OWNER ADDRESS PO BOX 361 YARMOUTH PORT MA 02675-0361 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 1 GENERATOR GRILLE INFRARED HEATER , LABORATORY COCKS MAKEUP AIR UNIT , OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER , WATER HEATER , OTHER . OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Thomas Coughlan LICENSE# 8529 SIGNATURE MP© MGF ❑ JP❑ JGF El LPGI ❑ CORPORATION 0# _ PARTNERSHIP ❑# LLC ❑# COMPANY NAME: THOMAS J COUGHLAN ADDRESS. 48 HERITAGE DR, CITY WALPOLE STATE MA ZIP 020812240 TEL FAX CELL EMAIL .t ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES T r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -- , z IN : _ 6. . . . 6 . . . I: MA DATE ( ( r I. PERMIT# �' `` BSITE ADDRESS 3Cj . -jj q 0,t L -/L3,OWNE 'S NAME T19 i $' ±t2 I INNER ADDRESS i TEL 1FAX ( TYPE OR ID P T -� CCUPANCY TYPE COMMERCIAL;] EDUCATIONAL _J RESIDENTIAL RIN CLEARLY EW: , RENOVATION: .) REPLACEMENT: PLANS SUBMITTED: YES•I NO.wN4V APPLIANC'ES 1 LS 1 FLOORS---' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 " OILER'- # 1 I ____l .___._.I I Y._.J __I __I __..__I __I ____J_..__.__i ._.___i BOOSTER ___! 1 I : I . ____I —J .--I -_._____I ___II —J. ___ __I_I � CONVERSION BURNER i I t I I-___l: I I _ _ '_._('_____I __1 -_1 _—__I COOK STOVE I - 1 . .. . _ g . .. . --- 1 .1 1 -� -�1:-J _.-_I _.I __-J -J __ —J DIRECT VENT HEATER i _I __I _I:, J. 1 _I ____I_ !,__I 1 I __ DRYER I I 1-_ _J I I j ._ . + . _. . .I --1 ' I . . i FIREPLACE I I , ( 1 1 1 .J _- _� ____1 __...__. i 1 ._ I _______1 _i._l FRYOLATOR - _ -_-- . - -. -- _ _ _ }- I . I : I I _ i _ 4 _ I ____...J ___ 0 FURNACE ._.J_._) _.__-_J,_____i .. I _ I _ 1 I 1 ; _�I __.�.I _- J I - J I GENERATOR 1 1 _i I ._ I _Y 1 ! _._ ! I I ' _ GRILLE i .._...__ _ _I �_i ._..I J __ J .a ._._ I __.__1 .___.1 . .1 .__.1 INFRARED HEATER __ ___ 1 __j I . .. . .I - _ I :—_I _... ' _._I I _____. ____( ._—.. I ________1 LABORATORY COCKS _._.___.( I ______I _s .�_._ I Y I I .___ .._�l __ I 1 r I I MAKEUP AIR UNIT --.___' . -„-y- l j 1 1 _____1_.., 1 J 1 _ ► ____1 _______I I. 1 OVEN I _..,_.__f .__.._i _ I ____ J .I ,_I __..i _______I, .___.._.._..1 ______I .______.r_i ______I. __.i 4,„ • POOL HEATER __...._I ; ____1 _ ,__ J _.-____rrI _.1 .w. _I J .____I rr_.J ___.J _ ____I ROOM ! SPACE HEATER ______ c _.._ I _ _ i .,_._ ..-1 1 ..�. • _..._.,. + ____._..1 _ i ._,_,1 i ROOF TOP UNIT 1 I j TEST _. _..... - _. __.. I ___` .._.._.�. .y._._-_J t ,I __._.. -I I UNIT HEATER . i i , - UNVENTED ROOM HEATER _,..__J _,__ _/ ___.. _�__ __�_.._. ..___.I - J _ __ _._i ,._..._.I _____� -- --I .�. ' WATER HEATER I j I I , �- ; • OTHER ' - . . . I - E _�.._,.,.._ -. .,..._r -- -- 1 I 1 I I I i ( 1 I -' __ 1 4 I • L . .-.. . .. ,. i 4.___._1 . i ..._____ ___._._....� _______i _..___..._� .__.,_..I , . 1 .__..� ! I 1 1 I ____! I ___1 ____,t _ _.� i _ ...' ...._... .___! ....- _I i J __--_ i INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO ;J. I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY V OTHER TYPE INDEMNITY BOND 1_1 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER .,_..-1 AGENT _..I SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be i mpliance with all rtinent pro • on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME '-'DH-O/j J LQ 6,-&AALICENSE# a.Q Al SIGN RE MP M GF °: J JP ' J 1 _____ . ____ __ .. _.._. GF ( LPG! I CORPORATION A# � I. PARTNERSHsdeF.IP :I# I._., p _ive,_ LLC I# COMPANY NAME:' 7-.1--L ...____ ___ -`e_ __ t (mot 1J/4-ADDRESS _ _ - - -- .- . ._. ----- 6 (n6-21.5 I cITY . -}A �M.ou -- _ . ._ .. STATE ZIP TEL - � I FAX I CELL: EMAILm � A I6 •• C..C3 -..---- fig--- _ I MAY 182021 1 I L __ _ ______I BUILDING DEPARTMENT 5 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$_ PERMIT# PLAN REVIEW NOTES